Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers

Background: Paternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints. Method: We employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups. Results: At 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing "crying". Limitations: While the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time. Conclusions: Interpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.